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CT Radiogenomic Characterization of EGFR, K-RAS, and ALK Mutations in Non-Small Cell Lung Cancer

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To assess the association between CT features and EGFR, ALK, KRAS mutations in non-small cell lung cancer.


Patients undergoing chest CT and testing for the above gene mutations were included. Qualitative evaluation of CTs included: lobe; lesion diameter; shape; margins; ground-glass opacity; density; cavitation; air bronchogram; pleural thickening; intratumoral necrosis; nodules in tumour lobe; nodules in non-tumour lobes; pleural retraction; location; calcifications; emphysema; fibrosis; pleural contact; pleural effusion. Statistical analysis was performed to assess association of features with each gene mutation. ROC curves for gene mutations were drawn; the corresponding area under the curve was calculated. P-values <0.05 were considered significant.


Of 285 patients, 60/280 (21.43 %) were positive for EGFR mutation; 31/270 (11.48 %) for ALK rearrangement; 64/240 (26.67 %) for KRAS mutation. EGFR mutation was associated with air bronchogram, pleural retraction, females, non-smokers, small lesion size, and absence of fibrosis. ALK rearrangements were associated with age and pleural effusion. KRAS mutation was associated with round shape, nodules in non-tumour lobes, and smoking.


This study disclosed associations between CT features and alterations of EGFR (air bronchogram, pleural retraction, small lesion size, absence of fibrosis), ALK (pleural effusion) and KRAS (round lesion shape, nodules in non-tumour lobes).

Key Points

Air bronchogram, pleural retraction, small size relate to EGFR mutation in NSCLC.

Pleural effusion and younger age relate to ALK mutation.

Round lesion shape, nodules in non-tumour lobes relate to KRAS mutation.

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The English text has been revised by Anne Prudence Collins (Editor and Translator Medical &Scientific Publications; Member AITI - FIT UNESCO; Member ASSOINTERPRETI).The data have been managed by Cristiana Fodor, data manager at Department of Radiotherapy, European Institute of Oncology, Milan (IT).

The scientific guarantor of this publication is Massimo Bellomi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.The authors state that this work has not received any funding. Sara Raimondi (one of the authors) is a statistician who kindly provided statistical advice for this manuscript. Institutional Review Board approval was not required because in this retrospective analysis all the patients had signed an informed consent to the use of clinical and imaging data for scientific and/or educational purposes. Written informed consent was obtained from all subjects (patients) in this study. Methodology: observational study, performed at one institution.

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Correspondence to Stefania Rizzo.

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Rizzo, S., Petrella, F., Buscarino, V. et al. CT Radiogenomic Characterization of EGFR, K-RAS, and ALK Mutations in Non-Small Cell Lung Cancer. Eur Radiol 26, 32–42 (2016).

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